Ian Burgess sets out how Calderdale council is supporting its social workers to stand up to other professionals in mental capacity cases

This is one of three articles supplied by the Adult Principal Social Workers Network for National Mental Capacity Act Action Day, on 15 March.

By Ian Burgess, MCA lead, Calderdale council

The five principles of the Mental Capacity Act 2005 are well applied by social workers because they chime with our professional values. The principles instruct us to be anti-discriminatory, to enable self-determination and to respect non-conformity.

But social workers can struggle when trying to convince other health and social care professionals of the lawful requirement to implement them when those professionals want to achieve a particular outcome, one determined without the person being involved at all.

Social workers have to be strong to resist the pressures put on them by others. So what can they do when other professionals pursue risk-averse options in the face of what the MCA requires? In Calderdale we have, every week, an MCA Clinic and a Risk Enablement Panel, both of which provide support for practitioners, often isolated in trying to uphold the human rights of the person.

Practice clinic

At the MCA Clinic, colleagues bring their MCA related queries and they are provided with written guidance. For example, a social worker recently brought a matter where a young woman with a learning disability was temporarily living in a care home while awaiting rehousing. The staff at the care home had taken the woman’s phone off her because she kept ringing her parents, asking them to let her live with them. The woman had the mental capacity to make the decision; indeed the social worker quoted the woman as saying: “If I don’t at least try then it definitely won’t happen!”

The social worker was provided with written guidance which he could put on case notes. He told the care providers they had to give the woman her phone back, they had no right to take it from her. If her parents were irritated by her calls, then that was a matter between them and their daughter.

At Risk Enablement Panel the social worker gets management sign-off for a non-risk averse decision to be made for an incapacitous person, one which respects the person’s known wishes and feelings, adheres to the best interests checklist and is the least restrictive option. The person is of course encouraged to attend where possible and we have a discussion about the consequences of the options.

Risk enablement

In one case, an older woman in hospital wanted to return home to her husband. Because of her dementia she could not fully understand the impact her care needs might have on her husband, despite attempts by the social worker to enable her to do so. Her husband had struggled to provide care but just wanted his wife home. He said: “We have been married nearly 50 years, why can’t we be together at the end of our lives?”

He agreed to an increase in home care and day care, which had previously been quite minimal. However the social worker faced a barrage of criticism from the ward staff at a meeting at the hospital. They maintained the woman must go into a care home and that it was unfair to put this on the husband because he was ‘old and vulnerable’ himself.

The panel supported the social worker by providing guidance on completing risk assessments and having a plan for a safety net should it be needed. We also wrote to the hospital trust advising that their views had been taken into account in the best interests decision making process, but that the decision maker was the social worker, and she had given weight to the opinion of the woman’s husband and the woman’s known wishes and feelings. The woman returned home and remained there for three months before needing to return to hospital where she died a couple of days later.

Until 2007, when the MCA came into force, social workers with adults lacked the legislative backing with which to challenge oppressive practice and promote independence. Championing the Mental Capacity Act has become the raison d’être for social work with adults.

On Twitter, people are being invited to tweet their thoughts and images on the MCA under the hashtags #mca and #unwisedecision. The Adult Principal Social Workers Network has been encouraging practitioners to post comments and photos illustrating unwise decisions they have made to highlight the importance of respecting the capicitated ‘unwise’ decisions of people receiving support. See a selection of people’s choices here.

Besides this piece, the network also supplied the following pieces for the action day:

What people want at the end of their lives is the least amount of interference and end it the way they wish not as dictated by others – making people miserable is not part of the Act – making decisions that dictate one persons values on another is subjugating them as if they do not have a life of their own
One persons subjective view is not enough to subjugate others
clinical views are not always best interest views GP have little understanding of best interest too busy playing God and professional arrogance gets in the way subjecting patients to their own views and ignoring the happiness and wishes of the patient care often not discussed with family enforcing action on the patient and little inclusion until after the act is done often too late and damage done – GPs often do not even believe they have to justify a clinical decision with best interest rationale – all decisions they subject a patient to they can say is clinical even of it crosses the boundary or personal choice – GP advice is just that not compulsory but the court seem to view it as compulsory for the patient